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Biomedical subjects

A G Morgan

Publications and source records attributed to A G Morgan.

At least 73 records · Page 4Linked to original sources
PubMed1988

Do the stigmata of recent haemorrhage have additional prognostic value in patients with bleeding duodenal ulcer?

To assess the additional prognostic value of endoscopic stigmata of recent haemorrhage (SRH) in addition to clinical data, a pilot study was conducted on 207 duodenal ulcer patients from the OMGE survey. The incidence of SRH was compared in 145 patients who settled and 62 who re-bled. Only active bleeding emerged as significantly commoner in the latter group. Two computer-assisted predictions of further bleeding (before and after addition of the stigmata to a clinical database) were compared with the final outcome. Little improvement, in terms of prognosis for further bleeding, was obtained when SRH data were added. Similar findings were observed in a smaller series from Marburg, FRG.

Diagnosis, Computer-Assisted↗
PubMed1988

Use of a multinational survey to provide clinical guidelines for upper gastrointestinal bleeding in developing countries.

The OMGE multinational survey of patients with upper gastrointestinal bleeding demonstrated that it was possible to predict patient outcome, using a computer and a database of information from many centres. It remained to be seen whether this database could be used in specific remote areas of the world. To answer this question, two areas have been studied, Sikkim and China. In Sikkim, when the computer-aided prognostic system was used, 69% of patients put into a high-risk group for rebleeding actually did so; and 54% died. By contrast, only 2% of patients placed into a low-risk group for rebleeding did so. As there is little computer technology in Sikkim, a simplified scoring system was developed which gave the same predictive accuracy as the computer system. In China there was a slightly lower accuracy with both systems. Hence a new database and scoring system were created, using only information from Chinese patients. This database improved the results. From the studies it is suggested that these types of systems can be of value to patients in remote areas by targeting patients at high risk rebleeding or dying, so that the scarce resources available can be best used.

China↗
PubMed1988

Topical anaesthesia for fistula cannulation in haemodialysis patients.

The use of a local anaesthetic cream (EMLA; Astra) for arteriovenous fistula cannulation was compared to placebo in a double-blind randomised manner in 26 patients undergoing chronic haemodialysis who were currently using injections of lignocaine. The EMLA cream was highly effective compared to placebo (P less than 0.001) on visual analogue and verbal rating scales as well as ease of venepuncture (P less than 0.01). It also gave more pain relief and improved the ease of venepuncture compared to lignocaine injections. Patients expressed a strong preference for the EMLA cream, which has advantages that outweigh the cost and convenience factors.

Adult↗
PubMed1988

OMGE international upper gastrointestinal bleeding survey, 1978-1986.

This presentation describes a further survey conducted under the auspices of the OMGE Research Committee: an international survey of over 4000 patients presenting to 205 clinicians in 44 centres in 21 countries. This multinational survey has been the first in this area of medicine to use specifically designed proformata and pre-agreed definitions of terminology, alongside automated data analysis. A total of 4506 patients' data were forwarded from 44 centres, the vast majority (4431; 98.3%) containing acceptable data fro subsequent analysis. The commonest cause of bleeding was peptic ulceration (36.7% of the total group), followed by oesophageal varices (13.3%) and gastric erosions (6.7%). Over 600 cases exhibited dual pathology. As regards outcome, in 1137 patients bleeding failed to settle (25.5%), whilst 409 patients died (9.2% of the total group, and 36.0% of those whose bleeding failed to settle). Detailed computer-aided studies show it is currently impossible to determine the source of bleeding without recourse to high technology such as radiologic or endoscopic intervention. If identification of the source of the bleeding is desirable clinically, then these high-technology investigations must be employed. As regard prognosis, a computer program has enabled categorisation of patients into risk categories as regards further or continued bleeding or death. This program has been tested on 2623 patients with considerable accuracy. In the computer's 'high-risk' category, 60% of patients re-bled, and 32% died. Conversely in the 'very low' risk category, only 4% re-bled, and no patient died. These findings have enabled the construction of a simple prognostic system for use in remote areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic Data Processing↗
PubMed1987

Causes of death in diabetic patients with impaired renal function. An audit of a hospital diabetic clinic population.

Of over 2000 diabetic patients whose serum creatinine had been measured regularly, 107 died between January, 1983, and March, 1985, and 27 (median age at death 66 years) had renal impairment (serum creatinine over 130 mumol/l). Cause of death was determined from clinical and necropsy data. 11 died of cardiovascular disease and 10 of causes unrelated to cardiac or renal disease; in only 6 was renal impairment the main cause of death. All 6 had severe physical and/or social disabilities and 2 were over the age of 75. Median serum creatinine in patients who died was 269 mumol/l (range 135-1135 mumol/l) and exceeded 500 mumol/l in only 5. Of the few patients who would have received RRT under a more liberal dialysis policy, all had severe physical disabilities.

Adult↗
PubMed1987

Does Caved-S decrease the gastric ulcer relapse rate during maintenance treatment with ranitidine?

Ninety-five patients with healed gastric ulcers were treated with ranitidine 150 mg at night plus either Caved-S two tablets twice daily, or an identical placebo preparation. Treatment was continued for 2 years: the recurrence rate after 1 year was 12.5% for single therapy and 19% for combined therapy, and 30 and 40% respectively after 2 years (differences not significant). No serious side-effects were encountered, but patients found the combination therapy difficult to take, and it conferred no clinical advantage. In a 3 month follow-up after stopping maintenance therapy, 11% of the patients had a symptomatic ulcer recurrence. It is therefore recommended that elderly patients with gastric ulceration should remain on maintenance therapy for life.

Adult↗
PubMed1987

Effect of dialysate fluids on phagocytosis and killing by normal neutrophils.

Inadequate host defenses may partly explain the problem of recurrent peritonitis in patients on continuous ambulatory peritoneal dialysis. It has been suggested that these defenses may be adversely affected by the fluids used for dialysis, and so we examined the effects of unused, effluent, and infected peritoneal dialysis fluids on phagocytosis and killing by normal neutrophils. We used a clinical isolate of Staphylococcus epidermidis as the test organism, as this organism is the most commonly cultured in continuous ambulatory peritoneal dialysis peritonitis; we also used a fungal species, Candida guilliermondii. There was no phagocytosis of either organism in unused dialysate because of lack of opsonins and low pH. Phagocytosis in effluent dialysate did not occur because of inadequate opsonin levels and was variable in infected effluents, depending on quantities of immunoglobulins present. Intracellular killing of both test organisms was normal in unused dialysate in the presence of 5% normal serum, but was reduced in effluent and infected dialysates because of factors inhibiting killing by neutrophils. These factors adversely affected the killing of S. epidermidis more than that of C. guilliermondii. These results may explain why peritonitis recurs, particularly peritonitis due to S. epidermidis, because organisms could be sequestered within the neutrophils and thus be protected from antibiotic action. Reinfection of the peritoneal cavity would then take place following neutrophil breakdown, causing a clinical relapse.

Candida↗
PubMed1987

Pulmonary vascular permeability to transferrin in the pulmonary oedema of renal failure.

Thirteen patients with renal failure and pulmonary oedema were assessed for evidence of increased pulmonary vascular permeability to protein by a double isotope technique. Comparison was made with 10 patients with cardiogenic pulmonary oedema, 11 healthy volunteers, and 10 patients with the adult respiratory distress syndrome. There was no significant difference in the accumulation of a radiolabelled plasma protein (transferrin) in patients with renal or cardiogenic pulmonary oedema and normal volunteers. Patients with adult respiratory distress syndrome showed significantly greater protein permeability (p less than 0.001). In pulmonary oedema associated with renal failure managed by current regimens there was no evidence of increased permeability to transferrin.

Adult↗
PubMed1987

Novel C3 nephritic factor activity in the glomerulonephritis of staphylococcal endocarditis.

A case of glomerulonephritis complicating staphylococcal endocarditis is presented. Hypocomplementaemia and a C3-activating factor in the serum suggested that the patient might have mesangiocapillary glomerulonephritis in association with C3-nephritic factor. Renal biopsy showed that this was not so and further examination of the serum factor showed that it differed from classical C3-nephritic factor because it was not an immunoglobulin. It is postulated that complement activation and glomerulonephritis in staphylococcal endocarditis may be the direct result of a bacterial product. A substance in the serum which activates C3 should be confirmed to be an immunoglobulin before the presence of classical C3-nephritic factor is assumed.

Complement Activation↗
PubMed1986

Removal and replacement of Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis.

8 episodes of persistent and 4 of recurrent bacterial peritonitis in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) were treated successfully by the removal and immediate replacement of the Tenckhoff catheter. Intraperitoneal antibiotics, which had previously failed to produce clinical resolution of the peritonitis, were continued unchanged. Dialysate culture yielded Staphylococcus epidermidis (3 cases), Staphylococcus aureus (1 case), pseudomonas species (5 cases), acinetobacter (1 case), and no growth in 2 cases. Clinical and microbiological resolution was achieved in all 12 cases within 36 h. CAPD continued uninterrupted in 10 cases. 1 patient required temporary haemodialysis for 6 weeks because of dialysate leakage and later restarted CAPD. 1 patient chose haemodialysis as his long-term treatment when his new catheter failed mechanically on the second postoperative day. Replacement of the Tenckhoff catheter at a single operation without interrupting CAPD reduces the demand which temporary haemodialysis of these patients makes on centre dialysis facilities and may preserve the peritoneal cavity for dialysis by preventing the formation of adhesions.

Adult↗
PubMed1986

Effect of continuous ambulatory peritoneal dialysis on a British renal unit.

Experience in the use of continuous ambulatory peritoneal dialysis (CAPD) for the treatment of end stage renal failure in Nottingham was reviewed. During six years 150 patients aged from 11 to 73 received this type of treatment. At three years patient actuarial survival was 69% and CAPD technique survival was 41%. Although CAPD was satisfactory as a first treatment for many patients, its long term use was possible in only a few. Actuarial survival of patients who changed to haemodialysis was 64% at one year after the change, suggesting that unsuccessful CAPD increased the risk of death. Hospital haemodialysis was the only suitable form of treatment for most patients in whom CAPD had been abandoned. British renal units have adopted CAPD to a much greater extent than those in Europe, but care in the selection of patients is necessary to reduce mortality, and many patients may eventually need hospital haemodialysis. Greater numbers of hospital haemodialysis places will probably have to be made available to meet this extra demand.

Actuarial Analysis↗
PubMed1986

A comprehensive rehabilitation service.

Integration of all rehabilitation services to the community is advocated to form a comprehensive rehabilitation service. This will embrace all age groups over 14 and combine geriatrics and physical medicine with paramedical personnel in a multidisciplinary team. Close liaison with psychiatric rehabilitation will be achieved by parallel use of a computerised client register. General practitioners will be actively involved. This reorganisation will better utilise available facilities and allow scope to develop two proposed new resources: (1) the use of mutual aid by matching of complementary residual skills of the handicapped; and (2) the provision of extra accommodation and care by host-attendants. To fully capitalise on this service, hospital boards should take active initiatives to foster the development of attendant care and the provision of sheltered housing in liaison with government departments, ACC, local bodies and charity organisations. In the long term, central government should consider a final common path for funding of services for disabled people.

Aged↗
PubMed1986

Experiences in day care and social competence among maltreated children.

The experience of 39 preschool-age maltreated children from 13 child care facilities was examined to determine the extent to which the children's social development was related to the quality of day-care service. Maltreated children assigned by the Arkansas Department of Social Services to three different types of child care facilities were observed: specialized day-care programs, regular day-care centers and family day homes. The children scored below average in intelligence and were rated by their parents as displaying higher than normal rates of disturbed behavior. While no comparison group of non-maltreated children was included in the study, observations of the maltreated children in the child care setting revealed substantially more positive than negative social behavior. The children were reasonably effective in interacting with adult caregivers in day care. The maltreated children were also productive in most encounters with peers. Ratings of the quality of care received in day care were significantly correlated with the children's social competence in child care. Aspects of social behavior in maltreated children were related to the organization of the program, the physical facilities, traits of the caregiver, and caregiver expectations for the children.

Child Abuse↗